‘Carebots’ are the mooted solution to the ageing crisis and staff shortages—but empathy and compassion are irreplaceable.
Can robots feel responsibility and commitment? Can they offer sympathy, compassion and kindness? Can they tell if someone is feeling lonely, sad, fearful or depressed? Can robots be caring? A report commissioned by the European Federation of Public Service Unions (EPSU)—‘Carebots’ and the care crisis—explores how technology is affecting care homes for the elderly and what it means for care work, now and in the future.
It is said we are on the cusp of an automation revolution promising to revolutionise support and companionship for senior citizens. Technology companies view Europe’s ageing population as a high-impact area for robotics research, as budgets increasingly reflect. The European Union’s flagship research programme, Horizon, contributes €1.3 billion to a public-private partnership exploring artificial intelligence, data and robotics, as well as supporting discrete projects related to robotics in care.
There is nothing objectionable about modifying domestic environments to assist elderly and disabled individuals to live better independently. Assistive-living technologies have long preceded the digital age. Today, they encompass innovations ranging widely from mobility aids through wearable monitoring devices to ‘smart home’ environmental-control systems. Attempts to automate care labour within workplaces—especially high-dependency settings such as nursing homes—are however a different matter. Unfortunately, certain industry narratives about the promise of automation tend to conflate the two.
The promised benefits of carebots are typically framed as a ‘fix’ for persistent labour shortages in the sector. For a chronically underpaid and understaffed workforce, the time needed to deliver quality, person-centred care is often lacking. Can robots come to the rescue, ‘saving labour’ while also lowering staffing costs and reducing pressures on public budgets?
Reasons to be sceptical
There are good reasons to be sceptical about the latest wave of robotic innovation. Social care has purportedly been on the threshold of an automation revolution for decades. Such techno-optimism is in reality a symptom of the care crisis, stemming from the undervaluation of care work. Poor working conditions, an ageing population and hence the perennially growing gap between demand for care and the supply of skilled labour will not be magicked away by replacing labour with machines.
So far, robotics has had very little impact on care, with few successes to support its claims. In Japan, where the most significant investments have been made, the results have been less than compelling. Rather than saving labour overall, robots have shifted human tasks from caring for people to supervising machines—often at vastly greater expense. The consequences, however, go deeper than costs.
Care is multifaceted: it covers a range of emotions, actions and behaviours to support and promote the wellbeing and comfort of others. It entails genuine concern for individuals’ welfare, including empathy, compassion and kindness. Removing the human interaction not only poses ethical issues about the privacy and comfort of elderly individuals but also deprives staff of the benefits of the personal relationships they establish with those in their care. Maintaining a human connection gives meaning to care work, even in the most over-burdened and stressful situations; its loss, amid changes in job roles and workplace dynamics, would compound stress and burnout.
Robotic pets remain the most commonly utilised robots in nursing homes. This has been the case for about 15 years, since the therapeutic robot called Paro, which resembles a baby seal, appeared on the European market. Animal companions can help alleviate isolation, reduce stress and enhance quality of life for senior citizens. Three clinical studies, in Australia, Japan and Denmark, however found no difference between Paro and ‘placebo Paro’—between Paro when it is on and a comparable soft toy. The novelty value of a robotic toy may be responsible for the joy and excitement, rather than the qualities of the robot itself.
Physical assistance
By extension, robots could in principle help alleviate the more onerous tasks for human caregivers, allowing them to focus on the more complex and emotionally demanding, if also rewarding, aspects of eldercare. After all, their labour is often highly physically strenuous—direct care workers are among the occupational groups most prone to musculoskeletal disorders. Physical-assistance robots, designed to perform tasks such as lifting, hoisting, carrying, bathing and dressing, could ease burdens while freeing up carers to be attentive in non-physical ways. Yet this promise has failed to materialise. Why?
Physical-assistance robots can be impractical and expensive, requiring more work to set up and supervise than the routine tasks they are designed to replace. But even beyond such obstacles, are they desirable? A recent survey of 3,800 care workers in Finland explored perceptions of this, in light of professional ethics and the complexities of human touch in care relationships. Acceptance of robots was highest for tasks that did not involve direct care, lowest for those involving touch. Care workers are deeply concerned by robotisation of care, because of the potential to reduce human contact and increase feelings of objectification on the part of care recipients. When human touch is replaced by machines, it is like severing a foundational connection.
Technological innovation in care settings should bring tangible benefits for recipients while reducing pressures on workers. While carebots may offer advantages, they must be assessed holistically for their impacts on the humans involved, as workers and home residents: the ethical considerations, changes to the quality of care, job displacement, changes in job roles, workplace dynamics and job satisfaction.
Expert professionals
Care professionals know which are the most effective tools for the job and what is most useful and beneficial in raising the quality of care. As true experts on innovation, they should be the ones articulating research priorities, rather than having innovation ‘done’ to them. By contrast, technologists—much more likely to be male—often have limited understanding of what care work entails. And the pursuit of profit-making under a rationale of cost-saving is inherently disconnected from an appreciation of care.
An important lesson can be drawn from Japan’s long experiment. While robotic technologies have faced prohibitive costs and poor implementation, sensible investments in digital workplace technologies have had much greater impact on care quality and efficiency. In Europe, many nursing homes, especially smaller ones, lag when it comes to basic information technology. Centralising record-keeping, reducing routine administration and improving digital communication greatly help overstretched care workers, making daily work more efficient and reducing the time workers spend on non-care tasks. Supported by appropriate training, such technologies alleviate stress and tend to be welcomed by care workers, as they free up time for direct care and interaction with residents.
The rapid transformation of AI technologies however gives rise to complex issues of digital rights. How are data created and collected in the course of caring activities and who then has access to them? Transparency is important, not only for compliance with the General Data Protection Regulation but also to ensure safety and mitigate risks in dealing with vulnerable individuals. And while advanced sensors and AI models can monitor health metrics, detect emergencies and provide timely alerts, these tools require human oversight.
The wellbeing, autonomy and dignity of elderly and vulnerable individuals must be at the centre of design and implementation of all technological innovations. The focus should thus be on enhancing and supporting human-centred care practices within long-term care settings, for the benefit of all concerned.
Samantha Howe is policy assistant on social services in the European Federation of Public Service Unions (EPSU), with a strong emphasis on care in Europe, including early childhood education and care and long-term care. She previously working with people with disabilities in Canada.
Karol Florek is an independent researcher specialising in health and care. Formerly national research officer for the United Workers Union in Australia, focusing on its care campaigns, since moving to Europe in 2014 he has undertaken research for the EPSU, PSI, UNI Global, CICTAR and the EESC.